The long-term objective of this project is to improve the detection of one of the common human cancers arising in the bladder by non-invasive voided urine-based tests. Bladder cancer is the 4th most common cancer in men and 5th most common overall with an approximately 68,800 new cases and 14,100 deaths from the disease in 2008 in the United States. It is estimated that nearly 300,000 patients are regularly monitored in the United States through a variety of non-invasive (urine) and minimally invasive (bladder barbotage, cystoscopy, and biopsy) techniques. Therefore, the development of novel biomarkers that can detect bladder tumors by a non-invasive approach is of major clinical significance. In this grant we propose to validate aurora A FISH test as a biomarker for the detection of bladder cancer in the multi-institutional validation protocol. In this protocol, we will compare the specificity and sensitivity of aurora A FISH test with other known noninvasive bladder cancer detection tests for voided urine sediments such as urine cytology and commercially available multi-chromosomal FISH kit known as UroVysion, and NMP22 point-of-care test. The specific aims for this proposal are as follows: Specific Aim 1: Determine the reproducibility of the Aurora A FISH test. Specific Aim 2: Validate a model for BC detection in patients with hematuria and determine if Aurora A FISH and/or UroVysion FISH improves the model. A previously described nomogram incorporating clinical variables and NMP22 will be validated. Furthermore, the Aurora A FISH and UroVysion FISH tests will be assessed for their ability to improve the current nomogram. Specific Aim 3: Determine the ability of Aurora A FISH to detect BC and determine its performance with cytology, UroVysion FISH, and NMP22. The sensitivity and specificity of Aurora A FISH will be determined. The performance of Aurora A FISH will be compared with cytology, UroVysion FISH as well as NMP22 and the ability of a combination of markers to improve detection will be explored. Specific Aim 4: Determine the ability of Aurora A FISH to detect patients with BC who are at high risk of tumor progression. Aurora A FISH performance will be compared with that of cytology, UroVysion FISH, and NMP22.